Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Dermatol. 2022 Oct;61(10):1245-1252. doi: 10.1111/ijd.16162. Epub 2022 Apr 10.
Data on Demodex in the immunosuppressed state is limited, focusing mainly on patients with human immunodeficiency virus and hematological malignancies. The aim of this study was to describe the manifestations of facial demodicosis in diverse immunosuppressive states.
The medical records of all patients followed at a Demodex outpatient clinic of a tertiary medical center from January 2008 to November 2020 were retrospectively reviewed. Data on patients who were immunosuppressed while with demodicosis were retrieved.
The cohort included 28 patients (17 women and 11 men; median age, 58 years). Types of immunosuppression included treatments with hydroxyurea for polycythemia vera/essential thrombocytosis, mycophenolic acid, tacrolimus, and prednisone for liver and/or kidney transplantation, prednisone with cyclosporine/methotrexate/azathioprine/rituximab mainly for autoimmune diseases, mercaptopurine with/without anti-tumor necrosis factor alpha (TNF-α) for Crohn's disease, chemotherapy for neoplasms, anti-TNF-α for psoriasis, and Cushing's syndrome. The clinical types of demodicosis included: papulopustular, erythematotelangiectatic and fulminant rosacea, hyperpigmented, pityriasis folliculorum, pustular folliculitis, and dermatitis. The diverse clinical presentations led to various differential diagnoses. Topical treatment with ivermectin (monotherapy/combination with other treatments) was effective.
Clinicians treating immunosuppressed patients should be familiar with the different forms of demodicosis and include them in the differential diagnosis of facial eruptions.
关于免疫抑制状态下蠕形螨的数据有限，主要集中在人类免疫缺陷病毒和血液恶性肿瘤患者。本研究旨在描述不同免疫抑制状态下面部蠕形螨病的表现。
回顾性分析 2008 年 1 月至 2020 年 11 月在一家三级医学中心的蠕形螨门诊就诊的所有患者的病历。检索到患有蠕形螨病同时处于免疫抑制状态的患者的数据。
该队列包括 28 例患者（17 名女性和 11 名男性；中位年龄 58 岁）。免疫抑制类型包括羟基脲治疗真性红细胞增多症/特发性血小板增多症、吗替麦考酚酯、他克莫司和泼尼松用于肝和/或肾移植、泼尼松联合环孢素/甲氨蝶呤/硫唑嘌呤/利妥昔单抗主要用于自身免疫性疾病、巯嘌呤联合/不联合抗肿瘤坏死因子-α（TNF-α）用于克罗恩病、化疗用于肿瘤、抗 TNF-α 用于银屑病和库欣综合征。蠕形螨病的临床类型包括：丘疹脓疱型、红斑毛细血管扩张性和暴发性酒渣鼻、色素沉着、滤泡性糠疹、脓疱性毛囊炎和皮炎。不同的临床表现导致了不同的鉴别诊断。伊维菌素局部治疗（单一疗法/与其他治疗联合）有效。
治疗免疫抑制患者的临床医生应熟悉不同形式的蠕形螨病，并将其纳入面部皮疹的鉴别诊断。
